Atopic Dermatitis - Symptoms and Treatment

Atopic dermatitis, also known as atopic eczema is a common skin problem in infants and children, but can also affect adults.

Atopic dermatitis in cubital fossa
Atopic dermatitis in cubital fossa

When the disease was first described, it was thought that it was a kind of skin allergy, related to other atopic conditions, such as allergic rhinitis, asthma and food allergies; hence the name atopic dermatitis. However, recent studies have shown that atopic eczema is not an allergic disease. It appears to arise on account of a genetic defect in a skin protein, which facilitates the onset of chronic inflammation and symptoms such as itching, flaking, redness and dry skin site.

What is atopic dermatitis

As mentioned in the introduction text, atopic eczema seems to be an inflammatory skin disease caused by one or more genetic defects in their proteins. The discovery of these defects has made to abandon the theory that atopic dermatitis is an allergic origin process.

As we all know, the skin is the body responsible for creating a barrier between the inside of our body and the external environment. It is our first line of defense against environmental aggressions. Intact skin prevents germs and irritants are able to reach the inside of our body.

The permeability of the skin is determined by a complex interaction between proteins and natural skin's own cells. Any perturbation of these components, either by genetic defects, trauma, decreased moisture, pH change or infection, may interfere with the ability of the epidermis to act as an effective barrier. The breaking of the skin barrier allows countless irritants from the environment can penetrate it and get in contact with the cells of the immune system that are located just beneath the skin. This interaction between absorbed irritants and the immune system leads to the release of proinflammatory mediators, producing the clinical and pathological findings of atopic dermatitis.

Similarly, the drop barrier and increased permeability facilitate invasion by irritating substances, it also allows increased evaporation of water from the skin, leaving it dry. The drying causes cracking, which contributes further to break the barrier against the external environment, exacerbating the symptoms of atopic dermatitis. This creates thus a vicious cycle.

Symptoms of atopic dermatitis

Atopic dermatitis is a typical disease of infants and children, but can also occur in adults. 85% of cases appears in the first 4 years of life; more than half of these, the inflammation goes away alone over the years. By adolescence, about 60 to 80% of patients no longer have more eczema.

In general, adults with atopic dermatitis are individuals who bring the disease since childhood. Only 1% of adults has atopic dermatitis beginning after adolescence.

Atopic eczema can be divided into three stages:
  • Children's Stage (3 months to 2 years old).
  • Pre-pubertal phase (2-12 years old).
  • Adult phase (from 12 years old).

The clinical picture of atopic dermatitis changes as the phase of the disease.

1. In the infant stage, the frame is red lesions, scaly, crusted and intense itching. The extensor surfaces of the joints, such as elbows and knees, face and scalp are the most affected areas. In some cases, the lesions can be very large and occupy a large part of the skin surface.

Interestingly, the area covered by diapers usually spared. In the most acute phase of the lesions may be vesicles (tiny bubbles) and elimination of purulent material.

2. In pre-pubertal phase, as well as redness and intense itching, it is also a very common skin thickening in the form of rough boards in the flexural surfaces of the joints, such as the cubital fossa (elbow fossa) and popliteal fossa (fossa knee). Neck, wrists and ankles are also frequently affected. At this stage, the skin is very dry and are common wounds caused by scratching.

3. In adulthood, the lesions of atopic dermatitis tend to be well thickened and pruritic. Eczema can be restricted to the hands and feet, but the neck, the cubital fossa and popliteal fossa are air often affected. Diffuse dry skin it is also quite common.

Generally, atopic eczema is an inflammatory condition of the skin that comes and goes, and there may be intervals of months or years between one crisis and another.

Eczema can cause intense itching, and scratching the injury can leave it still irritated and itchy. Itching may lead to lesions of the skin by the nail, which facilitates invasion and contamination of wounds by bacteria, especially Staphylococcus aureus.

Atopic dermatitis is not contagious. You can tap the injuries at ease that there is no risk of transmission.

Treatment of atopic dermatitis

The goal of treatment of atopic dermatitis seeks control of itching, reduction of skin inflammation and recurrence prevention.

One of the first steps in controlling atopic eczema is to eliminate factors that favor the aggravation of injuries, such as:
  • Heat, sweat, or dry environments.
  • Stress or anxiety.
  • Sudden changes in temperature.
  • Exposure to certain chemicals or cleaning solutions, including soaps and detergents, perfumes, cosmetics, pool chlorine, woolens or synthetic fibers, dust, sand or cigarette smoke.

Hydration of the skin is another necessary measure to relieve eczema. Moisturizers poor in water, such as Eucerin, Cetaphil and Nutraderm should be used daily after bathing. Vaseline is another valid option.

Topical creams containing corticosteroids are very useful to reduce skin irritation. The use of topical corticosteroids, however, should be restricted to the acute phases and last a few days to prevent side effects. When treatment with creams is needed for more than three weeks, it is best to avoid using steroids and products based on tacrolimus or pimecrolimos.

In the chaos of severe rashes and difficult to control, the use of steroids by mouth may be indicated for a few days.

Phototherapy, treatment with ultra-violet rays, is quite effective in controlling eczema. But it is an expensive treatment, which increases the risk of skin cancer and causes premature aging, which is why it won't be restricted to serious cases and difficult to control.

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